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* FREE AUDIO Reveals How to End Childhood Obesity
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NUTRITION FOR KIDS

Report Finds Energy Drinks Risky for Kids- not good .
Researchers Says Poison Centers Are Getting Calls About Caffeine
Overdoses in Children
A new research review finds that kids are big consumers of
caffeinated energy drinks, and experts say the beverages may be giving
young users unsafe amounts of stimulants and not good .
The special article, which is published online in the journal
Pediatrics, sounds the alarm about the increasing number of health
problems tied to caffeine use in youngsters. It calls for more caution
with the popular beverages, which are often sold in brightly-colored
cans with bold graphics and frenetic sounding names that may be
particularly attractive to tweens and teens, but is not good .
According to the review, 30% to 50% of adolescents and young adults
report using energy drinks, and consumers younger than age 26
represent half of the rapidly growing $9 billion market for these
beverages in the U. S. These beverages can contain three to five times
as much caffeine as an 8-ounce serving of soda.
But a spokesman for the American Beverage Association disagrees with
the report, noting that caffeine has been well tested and is generally
deemed safe.
Caffeine Overdoses in Kids
The researchers report that in 2008 there were more than twice as
many cases of caffeine toxicity reported to the nation's poison
centers each year in children as there are in adults.
“I really wouldn’t have expected the number of calls that
reported caffeine toxicity in children less than age 6,” says study
researcher Steven E. Lipshultz, MD
Researchers found roughly 1,200 cases of caffeine toxicity reported
to U.S. poison control centers each year in children younger than age
6 from 2006 through 2008.
And roughly half of all caffeine overdoses in the U.S. in 2007
occurred in children younger than 19.
“It is shocking,” Lipshultz says.
It’s impossible to know, however, how many of those might have been
related to energy drinks because they were not tracked as a separate
category in the years covered by the review.
But other countries, including New Zealand and Germany, have
documented increasing between and teen consumption of energy drinks,
sometimes with ill effects.
Reported outcomes linked to the consumption of energy drinks in
Germany, for example, have included liver damage, kidney failure,
respiratory disorders, agitation, seizures, psychotic conditions, high
blood pressure , heart failure , and disruptions of heart rhythms,
among others, according to the review.
Children and adolescents are more susceptible to the adverse health
effects of caffeine compared to adults, part of that may be that their
livers are not used to caffeine consumption regularly. So the first
time that kid buys an energy drink that contains 300 milligrams of
caffeine and drinks it, he’s not like his mom or dad and sits down
and has a cup and a half of coffee each morning. He’s never been
presented with that chemical before, and it’s a drug.
What’s more, researchers say, parents may equate energy drinks to
soda or sports drinks, when, in reality, they are very different, and
not considered good .
Under FDA rules, soda can’t contain more than 71 milligrams of
caffeine in every 12 ounces.
Energy drinks, on the other hand, are regulated as dietary
supplements, a designation that means there are no limits on how much
caffeine they can contain. Some are packed with as much as 500
milligrams per serving.
It’s become kind of acceptable, you wouldn’t put an espresso
machine in a middle school cafeteria. Nobody in their right mind would
do that. Everyone would be up in arms, and yet they think nothing of
putting these products in the vending machines.
Beverage Industry Responds
When it comes to caffeine, it’s important to put the facts in
perspective. Most mainstream energy drinks actually contain about half
the caffeine of a similar size cup of coffeehouse coffee. In fact,
young adults getting coffee from popular coffeehouses are getting
about twice as much caffeine as they would from a similar size energy
drink.
What we do know is that caffeine is one of the most thoroughly tested
ingredients in the food supply today. It has been deemed safe by the
U.S. Food and Drug Administration, as well as more than 140 countries
around the world. Many companies voluntarily list the amount of
caffeine on their products’ labels and have provided caffeine
content information through their websites and consumer hotlines for
years.
The American Beverage Association also took issue with the reports of
caffeinated overdoses reported to poison control centers, saying that
the researchers had mischaracterized the data.
Further, the review misinterprets the data from a 2007 study by the
American Association of Poison Control Centers, which reported more
than 5400 caffeine cases from pharmaceutical exposures, not exposure
to caffeine from foods or beverages.
The American Association of Poison Control Centers (AAPCC), for its
part, says the researchers got it right.
As indicated in the paper by Seifert et al., the category caffeine
refers to a broad category of caffeine-containing products. The
category includes approximately 300 products ranging from coffee to
caffeine tablets and various diet aids. At the time of these reports,
caffeine-containing energy drinks in the products database were also
included in this category.
What Parents Should Know
Energy drinks may be especially dangerous during sports, the jolt of
caffeine may interfere with something called coronary flow reserve,
which is the ability of the arteries around the heart to dilate during
intense exercise , a problem that may contribute to heart attacks and
abnormal heart rhythms in athletes.
The caffeine actually makes these arteries more likely to spasm and
actually shut.
Caffeine and taurine, which are commonly combined in energy drinks,
also makes the heart pound harder than caffeine would alone.
Other experts add that energy drinks may be harmful not just for
what’s in them, but what they may replace good , and drinks like
water and milk that hydrate and have minerals and protein that are
important for growing bodies. And many are high in calories, which may
contribute to obesity.
To learn more information about how to End Childhood Obesity to
listen to our free audio. So please help in your Family!

HEALTHY EATING FOR KIDS

OBESE KIDS

- Active Video Games Help Kids Burn Calories
Study Shows Kids With the Highest BMIs Enjoy ‘Exergames’ the Most
Help is just around the corner for and it’s fun too! Video games
that mix entertainment with exercise can help burn calories and have
fun at the same time, a new study shows.
The study had 39 middle-school aged play six different kinds of
“exergames” -- video games that require a player to move around.
The games included games such as trying to keep up with a cartoon
Jackie Chan as he hurdled down the streets of Hong Kong, boxing a
virtual opponent, and chasing colored lights on a mat, either to
follow dance moves or stomp on bugs.
Researchers compared the energy required to play those games or walk
on a treadmill at a speed of 3 miles per hour to energy expended at
rest.
Researchers found that exergames increased the amount of calories
each of the burned 400% to 800% over their resting metabolic rate, an
amount that was at least as good as treadmill walking .
Exergames and With High BMIs
Although all the obese kids said they had fun, the kids with the
highest BMIs were the ones who reported liking exergames the most.
Typically, these with higher BMIs might be less exposed to sports or
have a history of being less successful in activity-based games just
because it’s more difficult to move around.
It was capitalizing on their ability to be successful. In other
words, it was kind of built-in positive reinforcement.
Other experts say they have noticed the same phenomenon.
If you’re in grade three or four and you’re one of the last obese
kids picked for the team, that doesn’t do a lot for your
self-confidence.
The nice thing about the exergames is that because it’s
individualized, you can improve relative to yourself.
The study is published in the Archives of Pediatric Adolescent
Medicine.
Previous studies have shown that active video games can help increase
their physical activity, but experts who reviewed the study for WebMD
noted that this one was one of the first to look at how hard kids are
working when they play.
One thing that was unique about their study that I haven’t seen in
other studies was metabolic measurement, because you’re actually
measuring intensity, which is nice because people talk about it, but
now you can actually measure whether it’s moderate to extensive, the
effect of exergames on , but was not involved in the current study.
The study was also one of the first to measure enjoyment of
exergaming, experts say.
People, in general, tend to participate in activities they enjoy.
That’s true of adults, but it’s probably more true of children.
Indoor vs. Outdoor Play
Though exergames have the potential to get obese kids up and moving,
they can pose a quandary for parents.
The American Academy of Pediatrics recommends limiting the amount of
time obese kids spend in front of a TV or computer screen to two hours
daily.
But if are up and moving while they’re watching, does that count?
And is it OK to let obese kids spend a nice day indoors as long as
they’re playing Dance Dance Revolution?
These are not a substitute for being outside, riding a bike, being on
the soccer field.
If you’re going to let your obese kids watch TV or be on the
computer for two hours, substituting at least a half hour or one hour
of this time of active gaming would be a successful way to reduce the
amount of sedentary time that they have.
Spending time outdoors is the strongest correlate of physical
activity among pre-school aged children, although this topic has not
been well-studied with adolescents.
And experts note that obese kids can be fickle and that their
interest in exergames may wane over time, another reason why it’s
probably not a good idea to substitute Wii soccer for the real thing.
Active video games that require player movement should be thought of
as a way to complement a whole menu of choices to get active.
The key is to help parents think of exergames as an alternative that
offers variety rather than being a replacement for other forms of
physical activity.

To learn more information about how to End Childhood Obesity to
listen to our free audio. So please help in your Family!

CHILDHOOD OBESITY PREVENTION

NUTRITION FOR KIDS

Good Healthy - Help your children to develop habits by getting them
involved in the kitchen. Have fun with these .
The percentage of overweight children and teens has more than doubled
in the past 30 years. And are likely to become overweight or obese
adults — putting them at risk of heart disease, diabetes and other
chronic health problems.
But it doesn't have to be that way. Research has shown that children
— even teens — really do listen to their parents and follow their
lead. So set a good example and help your kids develop .
Start by pulling out a few fun and . Then invite your youngsters to
become junior chefs. Or ask them to pick their favorite recipes for
kids and offer to serve as their kitchen assistant.
Cooking together is the perfect opportunity to talk about
healthy-food choices. Give it a try with these tempting and tasty :

Breakfast of Burrito

Serves 1
Ingredients
1/2 cup chopped tomato
2 tablespoons chopped onion
1/4 cup canned corn
1/4 cup egg substitute
1 flour tortilla, 6 inches in diameter
2 tablespoons salsa
Directions
In a small skillet, add the chopped tomato, onion and corn. Cook over
medium heat until the vegetables are soft and moisture is evaporated.
Add the egg substitute and scramble with the vegetables until cooked
through, about 3 minutes.
To serve, spread the egg mixture in the center of the tortilla and
top with salsa. Fold in both sides of the tortilla up over the
filling, then roll to close. Serve immediate.

Baked Blueberry French Toast

Serves 9
Ingredients
12-inch French or sourdough baguette
4 egg whites
1 cup fat-free soy milk
1/4 teaspoon nutmeg
1 teaspoon vanilla
4 tablespoons brown sugar, divided
3/4 cup blueberries, coarsely chopped
1 tablespoon canola oil
1/4 cup chopped pecans, toasted (optional; not included in the
nutritional analysis)
Directions
Spray a 9-inch square baking dish with cooking spray. Cut 10
1-inch-thick slices from baguette. Arrange in baking dish. In a large
bowl, whisk egg whites until frothy. Then whisk in milk, nutmeg,
vanilla and 2 tablespoons brown sugar. Pour evenly over bread, turning
slices to coat evenly. Cover pan. Chill at least 8 hours or overnight,
until liquid is absorbed by bread. Preheat oven to 400 F. Drop
blueberries evenly over bread. In a small bowl, stir together 2
tablespoons brown sugar and oil, and pecans if you wish. Spoon evenly
over bread. Bake, uncovered, about 20 minutes, until liquid from
blueberries is bubbling.

Muesli Breakfast Bars

The original breakfast cereal called muesli — a German word meaning
"mixture" — combined rolled oats with nuts and fruit. The bars here
are perfect for breakfast on the go or for a healthy snack anytime.
makes 24 bars
Ingredients
2 1/2 cups old-fashioned rolled oats
1/2 cup soy flour
1/2 cup fat-free dry milk
1/2 cup toasted wheat germ
1/2 cup sliced (flaked) almonds or chopped pecans, toasted
1/2 cup dried apples, chopped
1/2 cup raisins
1/2 teaspoon salt
1 cup dark honey
1/2 cup natural unsalted peanut butter
1 tablespoon olive oil
2 teaspoons vanilla extract
Directions
Preheat the oven to 325 F. Lightly coat a 9-by-13-inch baking pan
with olive oil cooking spray.
In a large bowl, combine the oats, flour, dry milk, wheat germ,
almonds, apples, raisins and salt. Stir well to blend and set aside.
In a small saucepan, stir together the honey, peanut butter and olive
oil over medium-low heat until well blended. Don't let the mixture
boil. Stir in the vanilla. Add the warm honey mixture to the dry
ingredients and stir quickly until well combined. The mixture should
be sticky but not wet.
Pat the mixture evenly into the prepared baking pan. Press firmly to
remove any air pockets. Bake just until the edges begin to brown,
about 25 minutes. Let cool in the pan on a wire rack for 10 minutes,
and then cut into 24 bars. When just cool enough to handle, remove the
bars from the pan and place them on the rack to cool completely. Store
the bars in airtight containers in the refrigerator.

Tuna Pita Pockets

Canned tuna is a good source of low-fat protein and provides many
vitamins and minerals, including selenium, iron, magnesium,
phosphorus, vitamin B-12 and niacin. Here it's served with chopped
vegetables in a pita pocket for a quick lunch or light dinner.
Serves 6
Ingredients
1 1/2 cups shredded romaine lettuce
3/4 cup diced tomatoes
1/2 cup finely chopped green bell peppers
1/2 cup shredded carrots
1/2 cup finely chopped broccoli
1/4 cup finely chopped onion
2 cans (6 ounces each) low-salt white tuna packed in water, drained
1/2 cup low-fat ranch dressing
3 whole-wheat pita pockets, cut in half
Directions
In a large bowl, add the lettuce, tomatoes, peppers, carrots,
broccoli and onions. Toss to mix evenly.
In a small bowl, add the tuna and ranch dressing. Stir to mix well.
Add the tuna mixture to the lettuce mixture and stir to combine.
Scoop 3/4 cup of the tuna salad into each pita pocket half and serve
immediately.

Quesadillas

The traditional unleavened bread wrappers of Mexico, tortillas are a
versatile way to add grains to your day. Tortillas come in two basic
categories: corn and wheat. Wheat tortillas, made from white flour,
are often labeled "flour tortillas." Whole-wheat tortillas are made
from whole-grain flour.
Serves 16
Ingredients
4-ounce can diced green chili peppers, drained
Half a small onion, diced
1/4 teaspoon ground cumin
8 10-inch fat-free whole-wheat tortilla
2 cups (8 ounces) shredded reduced-fat Monterey Jack cheese
Directions
In a bowl, combine peppers, onion and cumin. Sprinkle each tortilla
with cheese, using 1/4 cup cheese on each. Divide pepper mixture among
tortillas, spreading it over cheese. Roll up each tortilla and put in
greased 9-by-13-inch baking pan. Cover pan with foil. Bake at 350 F
for 10 to 15 minutes, or until cheese melts. Remove foil. Turn oven to
broil. Broil 4 inches from heat for 1 1/2 minutes a side, or until
lightly browned. Cut each tortilla into 4 pieces. Serve with your
favorite salsa for dipping.

Barbecue Chicken Pizza

Vegetables, lean chicken breast and calcium-rich low-fat cheese makes
this pizza a healthy, well-balanced meal.
Serves 4
Ingredients
1 cup pizza sauce
1 12-inch Italian pizza crust
8 green pepper rings
1 tomato, sliced
1 cup mushrooms, sliced
4 ounces cooked chicken breast, sliced about 1-inch thick, with all
visible fat removed
2 tablespoons barbecue sauce
1 cup reduced-fat mozzarella cheese, shredded
Directions
Preheat the oven to 400 F.
Spread the sauce evenly over the pizza crust. Add the pepper, tomato,
mushrooms and chicken. Drizzle barbecue sauce over the pizza and top
with cheese.
Bake about 12 to 14 minutes. Cut the pizza into 8 slices and serve
immediately.

Healthy Baked Macaroni

The type of fiber in whole-wheat pasta is insoluble — meaning it
doesn't dissolve during digestion. Instead, it maintains its bulk,
holds on to water and, as a result, helps prevent constipation.
Serves 6
Ingredients
1/2 pound extra-lean ground beef
1 small onion, diced, about 1/2 cup
1 box (7 ounces) whole-wheat elbow macaroni
1 jar (15 ounces) reduced-sodium spaghetti sauce
6 tablespoons Parmesan cheese
Directions
Preheat the oven to 350 F. Lightly coat a baking dish with cooking
spray.
In a nonstick frying pan, cook ground beef and onion until the meat
is browned and the onion is translucent. Drain well.
Fill a large pot 3/4 full with water and bring to a boil. Add the
pasta and cook until al dente (tender), 10 to 12 minutes, or according
to the package directions. Drain the pasta thoroughly.
Add the cooked pasta and spaghetti sauce to the meat and onions. Stir
to mix evenly. Spoon the mixture into the prepared baking dish. Bake
until bubbly, about 25 to 35 minutes.
Divide the spaghetti among individual plates. Sprinkle each with 1
tablespoon Parmesan cheese. Serve immediately.

Healthy Strawberry Shortcake

Shortcake is a rich biscuit or yellow cake usually topped with sliced
fruit and whipped cream. This lighter version is topped with fresh
strawberries and plain yogurt.
Serves 6
Ingredients
1 3/4 cups Spelt flour, sifted
2 1/2 teaspoons double-acting baking powder
1/2 teaspoon salt
1 tablespoon sugar
2 tablespoons trans-free margarine
3/4 cup fat-free milk
For the topping
6 cups fresh strawberries, hulled and sliced
3/4 cup (6 ounces) plain fat-free yogurt
Directions
Preheat the oven to 450 F. Lightly coat a baking sheet with cooking
spray.
In a large mixing bowl, add the flour, baking powder, salt and sugar.
Using a fork, cut the margarine into the dry ingredients until the
mixture resembles coarse crumbs. Add the milk and stir just until a
moist dough forms.
Turn the dough onto a generously floured work surface and, with
floured hands, knead gently 6 to 8 times until the dough is smooth and
manageable. Using a rolling pin, roll the dough into a rectangle
1/4-inch thick. Cut into 6 squares. Place the squares onto the
prepared baking pan and bake until golden, 10 to 12 minutes.
Transfer the biscuits onto individual plates. Top each with 1 cup
strawberries and 2 tablespoons yogurt. Serve immediately.

Healthy Parfait

Serves 4
Ingredients
1 pint fresh strawberries, sliced
1 1/2 cups fresh blueberries
Creamy filling
1 cup low-fat, artificially sweetened vanilla yogurt
1/4 cup fat-free cream cheese, softened
1 teaspoon honey
Directions
Make creamy filling by placing yogurt, cream cheese and honey into
bowl and beating until fluffy. Assembly parfaits by placing 1/3 cup
strawberries in each parfait glass. Top each with 3 tablespoons of
creamy filling, then 1/4 cup blueberries. Garnish each by dividing
remaining topping. Chill until ready to serve.

To learn more information about how to End Childhood Obesity to
listen to our free audio. So please help in your Family!

CAUSES OF OBESITY

WAYS TO PREVENT CHILDHOOD OBESITY

Obesity Linked to Autism
Science is always looking for , a new study shows women who have
diabetes , high blood pressure , or are obese before pregnancy are
more likely to have a child with autism , according to new research.
For mothers with at least one of these conditions, there was a 60%
increased risk for autism in the offspring, says an autism researcher
at the University of California, Davis MIND Institute.
The researcher presented her findings at the International Meeting
for Autism Research in San Diego.
Autism and autism spectrum disorders (ASD) are a group of
developmental disorders that can cause significant social,
communication, and behavioral problems. About one in 110 U.S. children
has ASD, according to CDC estimates. Recent research from South Korea
has suggested the number may be much higher.
Seeking Clues on Development of Autism
In seeking , 1,001 children were evaluated. Of that group, 508 had
autism or ASD, 178 had developmental delays, and 315 were typically
developing children.
All were enrolled in the ongoing CHARGE study (Childhood Autism Risks
from Genetics and the Environment).
Researchers retrieved information on type 2 diabetes, obesity and
high blood pressure before the pregnancy by doing telephone interviews
with the mothers and looking at medical records.
In the search for the researchers decided to adjust for factors such
as a mother's education, the researchers found that mothers of
children with ASD were about 60% more likely to have one of the three
conditions.
The mothers of children who were delayed developmentally were about
150% more likely to be obese before pregnancy, have diabetes, or have
high blood pressure.
"This again is further evidence there is potentially metabolic
disruption and some sort of inflammatory pathway [linking the
conditions]," the researchers said.
In conclusion to finding , the researchers decided to explore the
link due to recent statistics showing an increase in diabetes,
obesity, and high blood pressure and the parallel rise in autism
rates.
The new research find new and a link between diabetes and autism
reflects findings of some earlier studies, according to Geraldine
Dawson, PhD, chief science officer for Autism Speaks, said,
"We have known from previous studies that a family history of
autoimmune disease such as type 1 diabetes increases the risk of
autism,” She reviewed the study findings but was not involved in the
research.
"What is interesting about this is, she has broadened the scope,"
Dawson says, by including obesity and high blood pressure in addition
to diabetes to find .
While no one can explain the mechanism of the link found, Dawson says
it is more evidence that the prenatal environment is important in
preventing autism and researching its causes.
“Fluctuating glucose levels that can occur in diabetes that is not
well controlled may affect adversely the unborn baby”, a researcher
for Autism Speaks, who also reviewed the study findings.
In this research to find, the best advice for now is: Women who are
obese before pregnancy, have high blood pressure, or have diabetes? To
make sure the mother and the baby get the best care see a high-risk
obstetrician.
This advice applies, to women who develop high blood pressure or
diabetes during the pregnancy as well as to those who have it when
they become pregnant and all pregnant women who are obese.
This study was presented at a medical conference. The findings should
be considered preliminary as they have not yet undergone the "peer
review" process, in which outside experts scrutinize the data prior to
publication in a medical journal.
To learn more information about how to End Childhood Obesity to
listen to our free audio. So please help in your Family!

CHILDHOOD OBESITY EPIDEMIC

SLEEP MORE AND FIGHT CHILDHOOD OBESITY

To help a new study found that preschoolers who sleep less are more
likely to be overweight or obese by the time they’re 7 years old,
even when diet and other lifestyle factors are taken into account.
According to the new study the amount of sleep a child gets may
affect their weight and their body fat, and most of that added weight
is stored fat, not muscle.
Sleep appeared to influence a child’s body weight more than both
diet and physical activity. Only maternal weight mattered more, in the
researchers' final analysis to help .
“The magnitude of the sleep effect was bigger than I expected,”
says study researcher Barry Taylor, head of the department of women
and children’s health in the Dunedin School of Medicine at the
University of Otago in New Zealand.
Experts who were not involved in the study say the findings are an
important contribution, and if anything, to we probably underestimate
the effect of sleep on weight.
“I think it’s consistent with what’s been seen in some of the
other research that’s been focused on this age group,” says
Michelle Garrison, PhD, a research scientist at Seattle Children’s
Research Institute. “Poor sleep during the preschool ages really
does seem to be associated with subsequent increased BMI scores.”
That is very important to !
The study didn’t account for periods of time that children might
spend awake in the middle of the night in their beds.
Children do have periods of time during the night when they are awake
and this is pretty common in kids this age. For example a child that
has”sleep duration" of 11 hours might really have only slept for 9.5
of those hours, after taking the child's night wakings into account.
But "that difference doesn’t discount their findings," Dr. Garrison
said, and he continued, “If anything, I think if they had looked at
true total sleep, the findings would have been even stronger."
Tracking Childhood Sleep and Body Weight
For the study, researchers followed 244 children from ages 3 through
7, regularly checking their sleep time, physical activity, diet, body
mass, and fat distribution.
Unlike previous research, which has typically relied on parents to
report how long children are sleeping, this study also used a more
direct measure: movement sensors that were worn by the children around
their waists.
To , researchers found that children slept an average of about 11
hours daily, with nearly all children in the study sleeping somewhere
between 9.5 hours and 12.5 hours each day, including naps.
Even after accounting for diet, physical activity, and a host of
other factors known to influence weight, each additional hour of daily
sleep children logged from age 3 to age 5 was associated with about a
half-point drop in the kids' body mass index (BMI) by age 7.
In a child of average height, which amounts to 1.5 pounds, and that
can add up, this is especially important to .
Children at the low end of the sleep scale had more body fat than
children who got more sleep. This was interesting; there was no
difference in muscle between shorter and longer sleepers.
Advice to Parents
Though this study shows a link between children's sleep and body
weight, it doesn't prove that getting less sleep causes weight gain.
And the researchers stopped short of offering parents advice about how
long kids should be sleeping or what to do if they are worried that
their children aren’t sleeping enough.
As a standard, especially in the : According to the National Sleep
Foundation, children need between 11 and 13 hours of sleep for kids
ages 3-5.
If children don’t seem to be hitting those targets, parents should
look at lifestyle factors that might be hampering a regular sleep
routine.
For kids this age, a lot of things can affect sleep quality, like TV
use and physical activity, computer use and stimulants before bedtime,
like sweets or caffeinated drinks, sweetened cereals, etc. A protein
snack before sleep is a much better choice.

To learn more information about how to End Childhood Obesity to
listen to our free audio. So please help in your Family!

CHILDHOOD OBESITY PREVENTION

Page 1 of 31

Stop Childhood Obesity

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